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Table 1 Summary of Study Findings

From: Delirium and other neuropsychiatric manifestations of COVID-19 infection in people with preexisting psychiatric disorders: a systematic review

ID
Country
Sample size (n)
Case# Diagnosis
Age
Sex
Description of neuropsychiatric outcomes Disposition GRADE
Beach 2020
United States
n = 4
(1) AUD—remitted, NCD
76 years
Female
Admitted with aggression, paranoia, alogia, and abulia. On examination had myoclonus, increased tone, and palmomental reflex. She was febrile with elevated CRP and bibasilar opacity on CXR. She was COVID positive on PCR. Head CT was nil acute and MR, EEG, LP were not done. She was trialed on olanzapine and haloperidol for management with poor effect. Switched to chlorpromazine and clonidine patch Palliative Very low quality
(2) AUD—remitted, NCD
70 years
Male
Admitted with aggression, staring, alogia, and abulia. On examination had cogwheel rigidity and myoclonus. An EEG showed diffuse slowing and generalized discharges and head CT was nil acute. He was COVID positive on PCR. Lorazepam was trialed for query catatonia with poor effect. His aggression and delirium were managed with physical restraints and valproic acid Improved
(3) Schizophrenia
68 years
Male
Admitted with a fall causing subdural hematoma (seen on head CT), UTI, AKI, and hypercalcemia. He was COVID positive on PCR. His longstanding clozapine and lithium were held, after which he developed agitation, alogia, abulia, and disorientation. He had mild tardive dyskinesia on examination. Delirium was managed with physical restraints and slow reintroduction of antipsychotics Improved
(4) MDD with psychosis, NCD
87 years
Female
Admitted with agitation, disorientation, and slurred speech. On examination she had myoclonus. She was tachycardic and had elevated CRP and was COVID positive on PCR. Delirium was initially managed with physical restraints and haloperidol, and later with quetiapine Deceased
Martinotti
2020
Italy
n = 6
(5) MDD
61 years
Male
Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose-ICDSC score 6, post-dose score 2 NR Very low quality
(6) MDD with psychosis
60 years
Male
Admitted with mild COVID pneumonia and fever. Developed hyperactive delirium, delusions of guilt, and suicidal ideation. Delirium managed with Abilify IM. Pre-dose ICDSC score 4, post-dose score 2 NR
(7) BD
58 years
Male
Admitted with COVID pneumonia requiring MV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose 2 Recovered
(8) MDD
64 years
Male
Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose score 2 NR
(9) BD
67 years
Male
Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose score 2 NR
(10) GAD
71 years
Male
Admitted with COVID pneumonia requiring NIMV. Developed hyperactive delirium and persecutory delusions. Delirium managed with Abilify IM. Pre-dose ICDSC score 6, post-dose score 0 Recovered
Palomar-Ciria
2020
Spain
n = 1
(11) Schizophrenia
65 years
Male
Admitted with 20-day history of bizarre behavior and incoherent speech, as well as new aggression, insomnia, echolalia, and disorientation. Head MRI was performed because of abulia, showing findings of encephalopathy. He had COVID positive antibodies but a negative PCR. He was managed with melatonin, haloperidol, and amisulpride Improved Very low quality
Suwan-wongse
2020
United States
n = 2
(12) BD
67 years
Female.
Admitted with disorientation, incoherent speech, AKI, and lithium toxicity (2.3 mmol/L). She was febrile and had bilateral infiltrates on CXR. She was COVID positive on PCR. Her lithium toxicity was managed with fluid resuscitation Deceased Very low quality
(13) ADHD, ASD, BD
18 years
Male.
Admitted with altered consciousness, AKI, and lithium toxicity (2.6 mmol/L). He was febrile and tachycardic. His CXR was normal and he was COVID positive on PCR. He was managed conservatively with fluid resuscitation and cessation of lithium with plan to restart as an outpatient Recovered
  1. AKI Acute kidney injury, AUD alcohol use disorder, ADHD attention deficit hyperactive disorder, ASD autism spectrum disorder, BD bipolar disorder, CRP C-reactive protein, CXR chest X-ray, CT computed tomography, EEG electroencephalogram, GAD generalized anxiety disorder, ICDSC intensive care delirium screening checklist, IM intramuscular, LP lumbar puncture, MRI magnetic resonance imaging, MDD major depressive disorder, MV mechanical ventilation, NCD neurocognitive disorder, NIMV noninvasive mechanical ventilation, NR not reported, PCR polymerase chain reaction, UTI urinary tract infection